Variations in physician practice and disparities in healthcare raise questions about the patient-centeredness of decisions that determine what care is provided to whom and whether this contributes to prevailing health and healthcare disparities. Variation in physician practice and persistent health disparities in chronic disease may, in part, be explained by a lack of patient involvement in treatment decisions, particularly among racial and ethnic minority patients. Yet the shared decision making experiences of vulnerable populations are poorly understood. The overall goal of this career development award proposal is to acquire knowledge, skill and expertise in shared decision making processes, the comparative effectiveness of shared decision making tools versus usual care, and the impact of decision support tools on health disparities in cardiovascular disease among culturally diverse, medically underserved populations. A strategy comprised of coursework and mentored research experience will provide expertise in shared decision making behaviors of vulnerable populations. A secondary data analysis will offer insight into the relationship between shared decision making and disparities in decision quality and outcomes. These findings will inform a qualitative interview guide for a series of semi-structured interviews designed to characterize socially determined predictors of shared decision making behavior and decision implementation difficulties. The research from these two studies will be translated into the development of a novel, health information technology driven, interactive shared decision making intervention with the goal of reducing healthcare access and communication barriers that limit full participation in the shared decision making processes for culturally diverse vulnerable populations.